insurance fraud investigation Archives

Who’s the Fraudster in Insurance Fraud?

Insurance fraud is a huge problem and insurance companies have gotten a reputation for being hard to work with on insurance claims. They see a lot of fraud and the red flags that pop up are taken very seriously. is called in by insurance companies when they see red flags. We don’t make decisions on cases. Our job is to find facts. Sometimes the facts just keep compounding. In one workers compensation fraud investigation, we were asked to surveil a claimant to determine if the patient was really disabled. Workers comp fraud is everywhere and the premiums are very expensive, in part because of the amount of fraud. Workers compensation investigation can include documenting the claimant’s activity as well as their contact with medical providers. [...]

Intuition Speaks Loud and Clear When You Need an Investigator

The staff at would like to remind you of a couple of old sayings. Both are about intuition. One of the sayings goes something like, “If you wonder if you can trust a person, you already know you can't” and the other is, “If it feels wrong, it usually is.” There are countless ways these sayings can apply to your career. If you are an insurance provider and your client tells you that his house just suddenly burned to the ground, you might get the feeling that your client is being dishonest and you have uncovered a case of insurance fraud. There may be red flags that pop up as you discuss the incident like the house being empty while they were away for a [...]

Surveillance Equipment Documents Workers Compensation Fraud

Like nearly every other business owner he knew, Lance paid close attention to the bottom line. He felt responsible for employees working in his chain of convenience stores. Many of those employees had been with Lance for more than a decade. In fact, Lance believed his stores were surviving the economic crunch because employees were friendly and fair to customers, just as Lance was friendly and fair to workers. That was exactly why Lance was upset about a workman's compensation claim filed two months ago by a new employee. According to the claim, the employee injured his back and neck when he slipped and fell on a freshly mopped floor. Other employees told Lance the wet area was marked with a cone and no one [...]

Hurrying Through Hiring and Skipping Background Investigation Has Consequences

Years ago, Bill learned his lesson, which is the fact that you just can't take anything at face value, especially people. Like all of those lessons that last a lifetime, Bill learned this information the hard way. It happened when he hired two new employees for the city courts system. There had not been enough time to adequately complete the HR due diligence checklist including background investigations, as Bill and his staff would normally do with new hires. At the time, the offices for the heavily populated city were grossly understaffed. The employees were all stressed out and overworked. All anybody wanted, at that time, were a couple of warm bodies to sit in front of the telephones and computers. As luck would have it, [...]

Insurance Fraud Covers More Than a Falsified Slip and Fall Claim

We have all heard the horror stories about employees who scam the system and cost their employer lots of money by filing false claims and committing workers compensation fraud. But another very real issue involves dishonest business owners who scam coverage providers. And so, when insurance companies contact about insurance fraud, we move swiftly to resolve the problems. Because, for every day that a dishonest business owner gets away with this crime, everyone else is at risk, whether we're talking about financial loss for the insurance carrier or benefit loss for innocent employees. Crooked business owners illegally reduce the owed amounts of workman's compensation premiums by hiding behind fake companies. This practice can be difficult to discover since the business may even provide bogus accounting [...]

Business Owners, Insurance Companies and Private Investigators Work Together to Eliminate Insurance Fraud

As our clients know, earned our excellent reputation because we are results oriented. Definitely, we think outside the box, approaching every case with a willingness to use whatever skills and resources necessary to gather evidence. Even the best of scam operators can't slide past our investigative tools since those tools and research skills are also mixed with persistence and the highest level of confidentiality. These facts about our agency bring insurance companies to our door. Recently a claims agent called because one of the business owners the company insures came to them with some concerns. He was certain that at least one of his employees was fraudulently collecting workers compensation benefits. But he had recently heard gossip about a second employee who was also drawing [...]

Is it Pain or is it Workers Compensation Fraud?

When their employee of less than six months claimed that her back was severely injured during a fall at work, Mary and Ted were alarmed. After all, their entire company was built on safety. In more than two decades of being in business, an employee had never been hurt on the job. But soon after the woman claimed to be too injured to return to work, Mary and Ted began to smell a rat. They spoke to other employees about the incident. Unfortunately no one had seen the woman actually fall. There was no video to review since Mary and Ted had never seen cameras as a necessity in their place of business. Shortly thereafter, the employee filed for workman’s compensation. Following that, Mary and [...]

Private Investigators Prove Insurance Fraud with Surveillance Video

When Wanda fell on a wet floor at work, she claimed to have suffered multiple injury-related problems. She quickly filed for workers compensation and sued her employer for millions of dollars in damages. Because they had no access to a videotape of Wanda’s slip and fall accident, her employers had no way of proving that she was lying – and committing insurance fraud. They heard a few grumbles around the community from Wanda’s co-workers and a few of her neighbors too, stating that Wanda was not only pretending to be injured, she was bragging about how she had her previous employer pinned to the ground like a bug. Frustrated and aggravated by the continuous stack of medical bills arriving in a thick manila envelope every [...]

Computer Forensics Investigations Reveal Truths – Wanted or Not

Computer forensics is not only used for criminal cases, but for civil cases as well. One illustrative case involved a worker who was placed on unpaid leave and then terminated. He filed a lawsuit against his employer alleging violations of the anti-retaliation provision of the False Claims Act and the Americans with Disabilities Act as well as the laws of the state of the occurrence. He told his attorney that several supervisors had conspired against him and that there were emails he had seen to prove it. The attorney obtained subpoenas for the computers of the supervisors and the terminated employee for computer forensics analysis. When the certified computer examiner began the process, he created a digital copy and found something unusual. The unallocated file [...]

Investigations and Social Security Numbers

Few people think much about their social security number, other than protecting it from identity thieves. But the actual number was – in the past – very telling. conducts a lot of investigation of specific people for a wide variety of reasons: A missing person investigation An identity theft An asset search Due diligence for personal or professional reasons Insurance fraud And a social security number can be a source of leads and information. But a relatively recent change adds some new challenges – and opportunities. The first three digits of a social security number used to stand for something specific. Each state had a certain series of numbers and other groups, like railroad workers, their social security number always began with digits from 700 [...]